Practice development
Practice development Innovations How to...
Table 2 describes the different types of lesions that can occur as a consequence of faecal incontinence.
FAECAL INCONTINENCE AND QUALITY OF LIFE The psychological impact of both faecal incontinence and the resultant skin damage should not be underestimated and can negatively impact patients' dignity, causing embarrassment and stigma[15]
. Lack of References
17. Gray M, Bliss DZ, Doughty DB, Ermer-Seltun J, Kennedy-Evans KL, Palmer MH. Incontinence –associated Dermatitis: A
Consensus. J Ostomy Continence Nurs 2007; 34(1): 45–54
18. Durnal A, Kommala D, Chen Y. Budget impact of adopting a faecal management system in a hospital intensive care unit: A single centre experience. 2009; ConvaTec Ltd
19. NHS Midlands and East. Pressure Ulcers. 2012; Available at: www.
stopthepressure.com (accessed 12 September, 2012)
20. Declaration of Rio. 2011; Available at:
http://silauhe.org/img/
Declaracion%20de%20Rio%20 -%20Ingles.pdf (accessed 12 September, 2012)
21. Benoit RA, Watts C. The effect of a pressure ulcer prevention programme and the bowel
management system in reducing pressure ulcer prevalence in
an ICU setting. 2007; J Wound Ostomy Continence Nurs 34: 163-175
22. Beldon P. The latest advances in skin protection. In: The
Identification and Management of
Moisture Lesions Wounds UK 2012; 8(Suppl 2): S6–8
23. Jones S, Towers V, Welsby S, Wishin J, Bowler P. Clostridium difficile
containment properties of a fecal management system: an in vitro
investigation. 2011; Ostomy Wound Manage 57: 38–49
24. Kennedy KI, Lutz I. Comparison of the efficacy and cost-effectiveness of three skin protectants in the management of incontinence
dermatitis. 1996; In: Proceedings of the European Conference on
Advances in Wound Management, Amsterdam
Table 3 . The available skin assessment tools.
The Incontinence- associated Dermatitis and its Severity Instrument
Borchert et al[27]
Assesses 13 body locations including peri- anal skin, genitals, buttocks,inner thighs, lower abdomen and suprapubic area
IAD skin condition assessment tool
N/A Kennedy and Lutz[24] NATVNS (2008 [25] )
Cumulative score with higher numbers indicating more severe IAD
Descriptive with 1–3 score
bowel control and subsequent odour can also impact on both social and physical functioning. Additionally, skin excoriation caused by faecal incontinence is an extremely debilitating and often very painful
condition[16] and as such can significantly impact on the patient's quality of life.
FINANCIAL COST In addition to the physical and psychological impact of faecal incontinence, there are significant cost implications in terms of increased length of hospital stay and the subsequent effect on employment. In these times of limited economic resources, all clinicians must be aware of safe and effective methods of reducing healthcare costs. Gray et al[17]
suggest that pressure ulcer
treatment data should include costs associated with skin injury caused by incontinence. Any financial analysis also has to account for the
Name of instrument Perineal assessment tool
Authors Nix[7]
Scoring
Cumulative scoring — the higher the score the higher the risk of IAD
Notes
Validated tool. Assesses risk based on: type of irritant; duration of contact; condition of perineal skin; total number of contribution factors
Score based on area of skin affected, degree of redness and depth of erosion
Designed to assess severity of excoriation and offers advice on skin care regimens. Clinical images used to aid assessment
Skin integrity: A clinical guide to 'best practice'
Mathison et al[26]
Descriptive — differentiating between excoriation, moisture lesions, pressure ulcers and combined lesions
Designed to assess skin changes including excoriation, moisture lesions, pressure ulcers and combined lesions; and management options including skin care regime, faecal management systems and pressure-redistributing surfaces, where relevant. Clinical images to aid assessment
Validated tool. Requires clinician to determine degree of redness, magnitude of skin loss and presence of rash
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